<!DOCTYPE html>
<html>

<head>

    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">


    <title> - 添加患者信息</title>
    <meta name="keywords" content="">
    <meta name="description" content="">

    <link rel="shortcut icon" href="favicon.ico">
    <link href="css/bootstrap.min.css?v=3.3.6" rel="stylesheet">
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    <link href="css/style.css?v=4.1.0" rel="stylesheet">
    <link href="https://cdn.bootcss.com/bootstrap-datetimepicker/4.17.47/css/bootstrap-datetimepicker.min.css"
          rel="stylesheet">

    <!--    3级联动    -->
    <script src="./js/distpicker_data.js"></script>
    <script src="./js/distpicker.js"></script>
</head>

<body class="gray-bg">
<div class="wrapper wrapper-content animated fadeInRight" style="margin: 0px auto; height: 400px;width: 2200px">
    <div class="row">
        <div class="col-sm-6">
            <div class="ibox float-e-margins">
                <div class="ibox-title">
                    <h5>添加患者信息</h5>
                    <div class="ibox-tools">
                        <a class="collapse-link">
                            <i class="fa fa-chevron-up"></i>
                        </a>
                        <a class="dropdown-toggle" data-toggle="dropdown" href="form_basic.html#">
                            <i class="fa fa-wrench"></i>
                        </a>
                        <ul class="dropdown-menu dropdown-user">
                            <li><a href="form_basic.html#">选项1</a>
                            </li>
                            <li><a href="form_basic.html#">选项2</a>
                            </li>
                        </ul>
                        <a class="close-link">
                            <i class="fa fa-times"></i>
                        </a>
                    </div>
                </div>
                <div class="ibox-content">
                    <div class="row">
                        <div class="col-sm-12">
                            <form role="form" action="http://arma3.f3322.net:2303/yiqing_war_exploded/test"
                                  method="post">
                                <div class="form-group">
                                    <!-- 省市区三级联动 begin -->
                                    <!--                                        <label class="col-sm-2 "><i>*</i>患者所在地址</label>-->
                                    <!--                                        <div class="col-sm-3">-->
                                    <!--                                            <select name="province" id="input_province" class="form-control" >-->
                                    <!--                                                <option value="">&#45;&#45;请选择&#45;&#45;</option>-->
                                    <!--                                            </select>-->
                                    <!--                                        </div>-->
                                    <!--                                        <div class="col-sm-3">-->
                                    <!--                                            <select name="city" id="input_city" class="form-control">-->
                                    <!--                                                <option value=""></option>-->
                                    <!--                                            </select>-->
                                    <!--                                        </div>-->
                                    <!--                                        <div class="col-sm-3">-->
                                    <!--                                            <select name="district" id="input_area" class="form-control">-->
                                    <!--                                                <option value=""></option>-->
                                    <!--                                            </select>-->
                                    <!--                                        </div>-->

                                    <label class="col-sm-2 "><i>*</i>患者所在地址</label>
                                    <div id="distpicker1">
                                        <select id="province" name="province1" class="select"
                                                style="width:180px;height:31px;"
                                                onchange=""></select>
                                        <select id="city" name="city" class="select" style="width:180px;height:31px;"
                                                onchange=""></select>
                                        <select id="district" name="district" class="select"
                                                style="width:180px;height:31px;"
                                                onchange=""></select>
                                    </div>


                                </div>
                                <br>               
                                <div class="form-group">
                                    <label class="col-sm-2 "><i>*</i>患者姓名</label>
                                    <input name="patientName" type="text" placeholder="请输入患者的姓名" class="form-control">
                                </div>

                                <div class="form-group ">
                                    <label class="col-sm-2 "><i>*</i>患者联系方式</label>
                                    <input name="patientTel" type="text" placeholder="请输入患者电话号码" class="form-control">
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2  draggable"><i>*</i>患者状态</label>
                                    <div class="col-sm-9">
                                        <select class="form-control" name="patientState">
                                            <option id="diagnose" value="2" selected>确诊</option>
                                            <option id="cure" value="1">治愈</option>
                                            <option id="dead" value="4">死亡</option>
                                        </select>
                                    </div>
                                </div>
                                <br>
                                <br>
                                <div class="form-group ">
                                    <label class="col-sm-2 "><i>*</i>患者确诊时间</label>
                                    <div class='input-group date' id='suretime'>
                                        <input type='text' class="form-control" name="suretime" />
                                        <span class="input-group-addon">
                                            <span class="glyphicon glyphicon-calendar"></span>
                                            </span>
                                    </div>
                                </div>
                                <div class="form-group ">
                                    <label class="col-sm-2 "><i>*</i>患者治愈时间</label>
                                    <div class='input-group date' id='curetime'>
                                        <input type='text' class="form-control" name="curetime" />
                                        <span class="input-group-addon">
                                            <span class="glyphicon glyphicon-calendar"></span>
                                            </span>
                                    </div>
                                </div>
                                <div class="form-group ">
                                    <label class="col-sm-2 "><i>*</i>接受治疗时间</label>
                                    <div class='input-group date' id='hardtime'>
                                        <input type='text' class="form-control" name="hardtime" />
                                        <span class="input-group-addon">
                                            <span class="glyphicon glyphicon-calendar"></span>
                                        </span>
                                    </div>
                                </div>
                                <div class="form-group ">
                                    <label class="col-sm-2 "><i>*</i>患者死亡日期</label>
                                    <div class='input-group date' id='dietime'>
                                        <input type='text' class="form-control" name="dietime" />
                                        <span class="input-group-addon">
                                                  <span class="glyphicon glyphicon-calendar"></span>
                                              </span>
                                    </div>
                                </div>
                                <br>
                                <br>
                                <br>
                                <div>
                                    <button class="btn btn-sm btn-primary pull-right m-t-n-xs col-lg-2" type="submit">
                                        <strong>提交</strong>
                                    </button>

                                </div>
                            </form>
                        </div>
                    </div>
                </div>
            </div>
        </div>

    </div>
</div>



<!-- 全局js -->
<script src="js/jquery.min.js?v=2.1.4"></script>
<!--<script src="https://cdn.bootcdn.net/ajax/libs/jquery/2.2.4/jquery.js"></script>-->


<script src="js/bootstrap.min.js?v=3.3.6"></script>
<script src="js/moment_with_locales.js"></script>
<script src="https://cdn.bootcss.com/bootstrap-datetimepicker/4.17.47/js/bootstrap-datetimepicker.min.js"></script>

<!-- 自定义js -->
<script src="js/content.js?v=1.0.0"></script>

<!-- iCheck -->
<script src="js/plugins/iCheck/icheck.min.js"></script>
<script>
    $(document).ready(function () {
        $("#distpicker1").distpicker({province: "吉林省", city: "通化市", district: "辉南县"});

        $('.i-checks').iCheck({
            checkboxClass: 'icheckbox_square-green',
            radioClass: 'iradio_square-green',
        });
    });
</script>

<!--Provice-->    <!--
    <script src="js/plugins/address.js"></script>
        <script >
            $(function () {
                var html = "";
                $("#input_city").append(html);
                $("#input_area").append(html);
                $.each(pdata,function(idx,item){
                    if (parseInt(item.level) == 0) {
                        html += "<option value="+item.code+" >"+ item.names +"</option> ";
                    }
                });
                $("#input_province").append(html);

                $("#input_province").change(function(){
                    if ($(this).val() == "") return;
                    $("#input_city option").remove();
                    $("#input_area option").remove();
                    //var code = $(this).find("option:selected").attr("exid");
                    var code = $(this).find("option:selected").val();
                    code = code.substring(0,2);
                    var html = "<option value=''>--请选择--</option>";
                    $("#input_area option").append(html);
                    $.each(pdata,function(idx,item){
                        if (parseInt(item.level) == 1 && code == item.code.substring(0,2)) {
                            html +="<option value="+item.code+" >"+ item.names +"</option> ";
                        }
                    });
                    $("#input_city ").append(html);
                });

                $("#input_city").change(function(){
                    if ($(this).val() == "") return;
                    $("#input_area option").remove();
                    var code = $(this).find("option:selected").val();
                    code = code.substring(0,4);
                    var html = "<option value=''>--请选择--</option>";
                    $.each(pdata,function(idx,item){
                        if (parseInt(item.level) == 2 && code == item.code.substring(0,4)) {
                            html +="<option value="+item.code+" >"+ item.names +"</option> ";
                        }
                    });
                    $("#input_area ").append(html);
                });
            });
        </script>  -->
<script type="text/javascript">
    $(function () {
        $('#suretime').datetimepicker({
            format: 'YYYY-MM-DD hh:mm',
            locale: moment.locale('zh-cn')
        });
    });
</script>
<script type="text/javascript">
    $(function () {
        $('#curetime').datetimepicker({
            format: 'YYYY-MM-DD hh:mm',
            locale: moment.locale('zh-cn')
        });
    });
</script>
<script type="text/javascript">
    $(function () {
        $('#hardtime').datetimepicker({
            format: 'YYYY-MM-DD hh:mm',
            locale: moment.locale('zh-cn')
        });
    });
</script>
<script type="text/javascript">
    $(function () {
        $('#dietime').datetimepicker({
            format: 'YYYY-MM-DD hh:mm',
            locale: moment.locale('zh-cn')
        });
    });
</script>

<!--    3级联动    -->
<!--<script src="./js/distpicker_data.js"></script>-->
<script src="./js/distpicker.js"></script>

</body>

</html>
